Provider Demographics
NPI:1629387543
Name:MOTA, ELIZABETH (PSYD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MOTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-2212
Mailing Address - Country:US
Mailing Address - Phone:213-996-7000
Mailing Address - Fax:213-996-7000
Practice Address - Street 1:640 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-2212
Practice Address - Country:US
Practice Address - Phone:213-996-7000
Practice Address - Fax:213-996-7000
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist